1.800.469.6292Plan Materials and Resources
Member Materials
| 2019 Annual Notice of Changes (ANOC) | English Español 中文 |  |
|---|---|---|
| 2019 Summary of Benefits | English Español 中文 | |
| 2019 Evidence of Coverage | English Español | |
| 2019 Provider and Pharmacy Directory | Bronx Brooklyn Manhattan Queens | |
| 2019 Formulary | English Español | |
| 2019 Extra Help Premium Summary Table | English Español 中文 | |
| Multi-language Insert | English Español 中文 Creole Русский Italiano 한국 | |
| Enrollment Form | English Español 中文 | |
| Prescription Drug Claim Form | English | |
| Appointment of Representative Form | English Español | |
| Health Care Proxy Form & Information* | English Español 中文 Creole Русский Italiano 한국 | |
| Part D Coverage Determination Form | English | |
| Member Reimbursement Form | English (coming soon) | |
| Part D Coverage Redetermination Form | English (coming soon) | |
| Prescription Drug Mail Order Form | English | |
| Privacy Notice | English | |
| Notice of Non-Discrimination | English Español 中文 Creole Русский Italiano 한국 | |
| 2019 Medicare Star Ratings | English Español 中文 | |
Member Resources
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CMS Best Available Evidence Policy |
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H2168_MKT19-06_M File & Use 09262018
This page was last modified on December 10, 2018
This page was last modified on December 10, 2018
